Individual
GAUTAM T DESAI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
447 RT 10, SUITE 2, RANDOLPH, NJ 07869
(973) 361-4555
(973) 361-6360
Mailing address
447 ROUTE 10, SUITE 2, RANDOLPH, NJ 07869
(973) 361-4555
(973) 361-6360
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA03468300
NJ
207RP1001X
Pulmonary Disease Physician
Primary
25MA03468300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2982803
—
NJ
Enumeration date
05/31/2006
Last updated
09/11/2025
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